Allergic Reactions/Anaphylaxis

Presented by: Mary Anne Javierto,RN Man

 An allergic reaction is a manifestation of tissue

injury resulting from an interaction between an antigen and an antibody. It is an inappropriate, often a harmful response of the immune system to normally harmless substances. PATHOPHYSIOLOGY

When the body is invaded by an antigen and the body recognizes as foreign, a series of events happen to render the antigen harmless, to destroy it or remove it from the body.

CHEMICAL MEDIATORS When mast cells (located in the connective tissues) are stimulated by antigens, strong and powerful chemical mediators are released to cause events and produce symptoms ranging to mild to life threatening. Also found in the basophiles. B Cells B lymphocytes are programmed to produce one specific antibody. On encountering a specific antigen, a B cell stimulates the production of plasma cells ( the site of antibody production.)

The result is the production of large amounts of antibodies T Cells The T cells or the T lymphocyte, assists the B cells in producing antibodies known as lymphokines that encourage cell growth, direct the flow of cellular activities, and stimulate the macrophages. A) stimulates the immune response. B) digest the antigens, C) assist in removing the dead cells and other debris D) prepare the area for healing

 Lymphocytes originate from the stem

cells of the bone marrow. The B cells mature in the red marrow, the T cells in the thymus gland. Once matured, they are released in the blood cells.

from the red cells, the in they populate in the lymphatic tissues, they can stay there or remains in the blood or other tissues

 Antigens Influences the production of B cells. They maybe known as Complete e.g. animal danders, dust and pollen. They stimulate a complete anaphylactic response. They maybe also known as Low molecular weight substances e.g. as medications or food. They function as haptens. The bind to tissues or proteins as carriers and produce a allergic reactions.

Chemical Mediators of Hypersensitivity I. Primary Mediators Histamines - effects -Plays a role in the immune response. Maximal intensity is reached within 15 minutes after antigen contact. The following effects follows: Vasodilation erythema localized edema in the form of wheals and pruritus contraction of the bronchial smooth muscle resulting to wheezing, difficulty of breathing Increased secretions of gastric and mucosal cells resulting to diarrhea, abdominal pain

Eosinophils Chemotactic Factor of Anaphylaxis inhibits the action of leukotrines and histamines affects movement of eosinophils Platelet activating Factor responsible for initiating platelet aggregation on sites of hypersensitivity reactions Produces bronchoconstriction Increased vascular permeability Activates Hageman factor which stimulates the production of Bradykinins

Prostaglandins produces small muscle contractions Vasodilation Vascular permeability II. Secondary Mediators Leukotrines These are released by the mucosal mast cells . They are collectively known as the Slow Reacting Substance of Anaphylaxis. initiates the inflammatory response smooth muscle contraction bronchial constriction

 causes wheals and flare reactions noted in the

skin Mucus secretions in the airways Extremely potent in causing vasospasm Bradykinins A polypeptide wit the ability to cause : Increased vasopermeability Vasodilation Hypotension Contraction of the bronchial muscle leading to spasms and dyspnea. Stimulates nerve endings that causes pain

ANAPHYLACTIC SHOCK The result of a

widespread hypersensitivity reaction. The symptoms maybe seen as vasodilation, pooling of blood in the periphery and hypovolemia and with altered cellular metabolism. Occurs as a response when an allergen reacts strongly with the antibody Does not occur in the first exposure With the first exposure, the body manufactures antibody specifically,IgE antibodies begins and progresses rapidly and is potentially lethal

 CAUSED BY AN INTERACTION BETWEEN AN OFFENDING ANTIGEN AND SPECIFIC IGE ANTIBODY FOUND ON THE SURFACE MEMBRANE OF THE MAST CELLS. SENSITIZATION STAGE THE BODY PRODUCES IGE ANTIBODY

THIS PROMOTES RELEASE OF VASO ACTIVE CHEMICAL MEDIATORS

COAGULATION FACTORS, LYMPHOCYTES, EUSINOPHILS, SMOOTH MUSCLE SPASMS

Bronchospasm, mucosal edema, inflammation And capillary permeability. These symptoms are produced within seconds of initial contact

Other symptoms that may soon follow are: laryngeal stridor, hypotension, laryngeal, GI and uterine spasm.

CLINICAL MANIFESTATIONS CATEGORIES mild moderate severe

Allergic reactions can be provoked by :

a.skin contact with poison

Any medication has the potential to cause an allergic reaction.

plants, chemicals, animal scratches, insect stings. b. Ingesting or inhaling substances like pollen, animal dander, molds and mildew, dust, nuts and shellfish c. Medications such as penicillin and other antibiotics

A. MILD REACTIONS: 1. REDNESS, PRURITUS, URTICARIA AND SWELLING

MODERATE REACTIONS: 1. MILD REACTIONS 2. SLIGHT DIFFICULTY IN BREATHING, SOME USE OF ACCESSORY MUSCLES 3. INTENSE ITCH, REDNESS AND MORE EDEMA 4. FLARING OF THE ALAE NASAE 5. FATIGUE AND WEAKNESS SEVERE REACTIONS: 1. MODERATE REACTIONS 2. RESPIRATORY ACIDOSIS, DYSPNEA, STRIDOR, PULMONARY EDEMA, DECREASED BREATH SOUNDS, XRAY SHOWS SEVERE PULMONARY CONGESTION

B. Cardiovascular pallor, clammy skin Tachyarrythmias Hypotension Decreased oxygen saturation hypoxemia and hypercapnea Warm to touch if febrile
C. Neurologic anxiety, restlessness, inability to obey commands Decreasing level of consciousness, coma and unresponsiveness

D. Renal decreased urine output less than 30cc/hr. E. Integumentary maybe febrile redness,,presence of wheals edematous (lips, mouth and tongue, periorbital, scalp and genitals

MANAGEMENT
DRUGS
SYMPATHOMIMETICS AMINOPHYLLINES / THEOPHYLLINES a. check B/p & heart rate b. respiratory assessment EPINEPHRINE / ADRENALINE check B/p & heart rate ANTIHISTAMINES blocks histamine receptors a. do not allow the pt. to drive b. monitor b/p diphenhydramine atarax claritin

 Oral corticosteroids anti-inflammatories and regulate immune response. Monitor blood sugar levels Decadron Hydrocortisones (solucortef) Medrol and solumedrol Diuretics Lasix and Mannitol - determine blood pressure, do not give for b/p below 100 systolic. Monitor intake and output Na Bicarbonate monitor ABGs and electrolytes Albumin infusions and Isotonic Infusions to allow fluids to remain within the vessels and increase cardiac output & b/p

NURSING INTERVENTIONS: Administer epinephrine. Monitor blood pressure and heart rate. Must be connected to cardiac monitor. O determine arrythmias. Maybe given subcu or IV or intratracheal. Increases b/p, cardiac output, heart contraction and rate. Aminophylline promotes bronchodilatation and relaxation of the bronchial muscles. Given through inhalation or IV. Increases oxygenation

TREATMENT
Anaphylaxis is always an emergency. It requires an immediate injection of epinephrine. In the early stage of anaphylaxis, when the patient still has normal blood pressure and is conscious, give epinephrine I.M. or subcutaneously S.C. Massage the injection site to help the drug move into circulation faster. With severe reactions, when the patient lost consciousness and is hypotensive, administer epinephrine I.V.

 After the initial emergency, give other

medication as ordered: epinephrine solution or suspension S.C., corticosteroid, and diphenhydramine I.V. for long-term management, and aminophylline I.V. over 10 to 20 minutes for bronchospasm. Evaluate the patient. On recovery, his blood pressure should be within normal limits and his respirations should be regular and unlabored.

Teaching tips for Anaphylaxis

To prevent anaphylaxis, teach the patient to avoid

exposure to known allergens. If he has a food or drug allergy, tell him to avoid the offending food or drugs in all its forms. If he has allergic to insect bites or sting, tell him to avoid open fields, and wooded areas during the insect season and to carry an anaphylaxis kit (containing epinephrine, antihistamine, and tourniquet) when outdoors. Advise the patient to wear medical identification jewelry identifying his allergy.